Overview of Depression Mgmt during Pain

Depression Management during the Presence of Pain: An Overview – January 20, 2015 – free full text article

Depression and anxiety are frequently associated with increased risk of medical problems. The severity of these problems varies from persistent pain to severe cardiovascular illness.

The pathophysiology of chronic pain and depression overlap in the noradrenergic and serotonergic pathways.

Antidepressants, especially dual acting which affect both pathways, are a frequent and effective choice of treatment for chronic pain.

The effectiveness of antidepressants for pain has not been proven and many pain patients get zero relief from them, including me.n

Although the coexistence of depression and pain, the treatment differs in terms of depression pain comorbidity and painful symptoms in depression.

The aim of this study is to discover and integrate the data about pain.

Results: We found evidence of a strong relationship between pain perception and depression.

Are they trying to minimize “real pain” by calling it merely the “perception of pain”?

I suspect that depression only alters our perceptions, not the reality, of our pain.

Regardless of the comorbid problem, untreated or undertreated chronic pain has significant physical, psychological, social and financial consequences.

One of the frequent co-morbidity of chronic pain is depression. This coexistence is not astonishing according to the involvement of some common regions of brain and pathways.

This is also not astonishing because pain is a miserable stressful experience that would make anyone depressed after enough years had gone by.

Three categories of chronic pain are recognized:

  1. neuropathic pain ( the result of a damage or dysfunction either in peripheral nerves or central nervous system),
  2. inflammatory pain and 
  3. non-inflammatory non-neuropathic pain (also called functional pain).

It may be difficult to identify the painful symptoms of depression and pain syndromes associated with depression. Since the treatment approaches are different, sagacious clinical decision is important for the choice of the treatment.

Alterations of serotonergic and noradrenergic pathways in the central nervous system are the common pathological roots of depression and chronic pain.

Clinically, severe pain at onset of symptoms predicts poor response to the depression treatment.

That’s not surprising (again) considering that pain is a miserable stressful experience.

#Researchers routinely avoid including the actual effects of pain, its misery, its physical torment, and the hopelessness of it being cured.

Seratonin has a unique role in pain pathways. It plays an algogenic (Causing or referring to pain) role in peripheral tissues although it acts as an endogenous analgesic role in central nervous system.

Unfortunately, this paradigm supports the use of antidepressants which inhibit monoamine and serotonin reuptake for the treatment of painful physical symptoms in depression and anxiety.

I find it insulting that they believe our severe excruciating pain could be caused by depression and anxiety. Only mild “aches and pains” magnified from fairly normal conditions are possible from being depressed and anxious.

Dual-acting antidepressants (venlafaxine, duloxetine, milnacipran) have more specific actions on the overlapping pathology of depression and pain

the subtypes of the receptors they interfere [with] may differ leading various analgesic effects. Although some authors do not confirm the difference of their analgesic effects

review of the literature suggests that the efficacy of antidepressants (especially SNRIs) may differ and their action may be disease specific.

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4 thoughts on “Overview of Depression Mgmt during Pain

  1. Richard A Lawhern, Ph.D.

    I have written in this area of medical and psychological practice. One of my more challenging articles in the subject is “Psychogenic Pain and Iatrogenic Suicide” on the Global Summit for Diagnostic Alternatives of the Society for Humanistic Psychology. I personally believe that there is no such thing as psychogenic pain (e.g., pain caused by or originating in depression or anxiety). However, it is plausible that depression and anxiety grow out of chronic pain and may be traceable to changes in the nervous system introduced by toxic byproducts of prolonged pain responses. It is also plausible that when depression and anxiety are eased in non-pharmacological therapies, stress-related hypersensitivity to pain stimuli might be reduced.

    See http://face-facts.org/lawhern/lawhern-009/

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  2. Angela M. Oddone LCSW, Resiliency Strategies LLC

    Fortunately, we now know more about the influence of genetics on how people metabolize drugs. Pharmacogenetic testing can be ordered by a PCP or specialist. Insurance covers it. And, all it requires is a cheek swab. Because people who have genetic connective tissue disorders that cause us to metabolize drugs differently, the information gained can save a person from potentially harmful side effects. As I’m now seeing more clients who live with chronic pain and/or complex, chronic, rare illnesses via phone or Internet, I’m often recommending pharmacogenetic testing because one size does not fit all.

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    1. Zyp Czyk Post author

      I’m so frustrated by the medical push to standardize, just when we’re learning more and more about the wide genetic variability among individuals. These two paradigms are in direct opposition.

      Standardization of treatment seems mainly motivated by its potential to generate more profit for the corporatations owning our healthcare these days, because it’s certainly not helping patients who have complex problems like chronic pain.

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